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There is considerable disagreement over the exact nature of autism. It is generally believed to be a spectrum or cluster of physical, mental and emotional conditions, of varying severity, none of which are well understood. Despite the many physical conditions comorbid to autism spectrum disorders, diagnostic criteria, as of 2006, is still limited to psychiatric evaluation methods.

The cause(s) of autism and the spectrum of pervasive developmental disorders (PDDs) are as yet unknown, as are the prognoses, or best treatment options. There is, however, widespread agreement that early diagnosis and intervention can often make a significant difference for an autistic person's long-term prospects, because the human mind and nervous system are more plastic at a younger age. Therefore, there is a focus on research for possible therapies and treatments that will be helpful to children diagnosed early with a spectrum disorder. However, many adults on the autistic spectrum, and other interested parties, believe that this emphasis on the problems facing children has often limited research and treatment options associated with adults with autism.

The medical community considers autism to be essentially incurable at this level of knowledge about the disorder, or at least to have life-long effects. Meanwhile, judging by the plethora of material on the internet and elsewhere, many autistic spectrum adults and neurotypical (non-autistic) allies in the autism rights movement do not consider autism to be a disorder, but simply a different way of perceiving and behaving. These people believe that at least some of the difficulties encoutered by people with autism may result from prejudice and lack of accommodation from society.

With knowledge being so limited, and scientific progress slow, nearly all aspects of dealing with autism are hotly debated. Parents of autistic kids face a bewildering set of choices, and attendant uncertainty about the merits of various diagnoses, prognoses, and alleged 'cures' and treatments. Some of these controversies are described below.

The usefulness and accuracy of autism as a diagnosis

The 1994 DSM-IV criteria for the diagnosis of autism is the result of several revisions, the psychiatric community is divided as to whether the condition should be ordered by severity along a spectrum, or categorised into multiple distinct disorders that have similar symptoms. This division is exacerbated by the wide range of conditions comorbid to autism spectrum disorders. Research and clinical experience suggests that, while autism may appear to manifest as a psychiatric disorder, its underlying causes are neurological. PDD has emerged as an overarching descriptive term for the cluster of disorders that includes autism.

A diagnosis of autism is complicated by the fact that there is no definitive test, due to the significant variance in the severity of symptomology among people with autistic traits. Those with Asperger syndrome may be highly functional cognitively, but lacking 'social' skills, whereas others with 'profound autism' may be non-verbal and deficient in elementary skills. Some autistic people are 'mentally retarded', having low IQs (Intelligence Quotients); others have average or above average intelligence; and a minority have narrow, but exceptional autistic savant abilities.

This is not just an academic issue - treatment strategies and choices are based on definitions of what needs to be changed. Different treatment approaches have had widely divergent outcomes for the autistic person - some parents claim their children recovered with only behavioral approaches, some with biomedical intervention, and others report little or no progress after trying many different approaches. Other parents claim their autistic children have simply "grown out of it".

There are also those (primarily the autistics themselves) who reject the premise that autism is necessarily a disorder that should be cured. In their view, a diagnosis can sometimes result from a judgment of non-conformity that is followed by efforts to correct what are essentially personality traits.

Asperger's and autism

Currently, Asperger syndrome is classified as a separate diagnosis from autism in the DSM-IV, but is still considered an autism spectrum disorder. The primary distinction between the definitions in the DSM-IV is that autism involves a speech delay and Asperger's does not. Many people believe autism and Asperger's syndrome should not be given separate labels in the DSM-IV because of differences in language acquisition, others because they believe autism and Asperger's to have no definitive differences. It is also unclear whether an autistic child who learns to speak and is high functioning should have their diagnosis changed to that of Asperger's Syndrome.

Geeks and nerds

It has been suggested that so-called geeks and nerds are persons with undiagnosed Asperger's syndrome. This has been disputed by professionals who indicate that geeks and nerds simply exhibit normal variant behavior, not pathological behavior. Many people diagnosed as showing Asperger's syndrome believe their behavior is not 'abnormal' per se, and reject the notion that any divergence from a supposed ideal should be considered pathological. There are cases of persons who considered themselves simply geeks or nerds but later realize a diagnosis of Asperger's may apply to them, for example after having a child diagnosed autistic.

Since the terms 'geek' and 'nerd' are social stereotypes rather than terms that can be genetically or behaviourally defined, this issue has not been resolved. Some suggest that there is a trend to pathologize almost any variant human behavior (e.g., ADHD) which could be interpreted as a method of phasing out ad hoc terms such as 'geek'.

'Autistic' vs. 'Has autism'

Individuals who describe themselves on the internet as autists have repeatedly stated their preference for the word autistic to be used as an adjective, as opposed to a pronoun. That is, they dislike the so-called person-first terminology. In fact, it appears the vast majority of persons diagnosed as autistic who express their views verbally or in writing hold this position, across the spectrum.

Person-first terminology is preferred by many of those with diseases or medical conditions, such as AIDS or epilepsy, where it may serve to remove some of the stigma of these illnesses. Many in the autistic community feel that to use person-first language connotes that autism is another such disease, something that can and should be cured. These autistics feel that autism is an integral part of their identity. Even if autism could be removed, they say that would be akin to ceasing to exist.

As with other such arguments involving the autism rights movement, many parents of autistic children disagree with the position of the autistic self-advocates. They contend that their children, in fact, "have autism", implying that autism is not part of the child and should be 'removed' or 'cured'. Such parents often cite regressive autism, mercury poisoning and other arguments as support for this position.

Person-first terminology appears to be the preferred form in the autism literature, but people who are not emotionally involved in these arguments are generally not bothered by either usage.

Epidemiology of autism

There is uncertainty and controversy over whether the incidence of autism is actually increasing, or if there simply is an increase in the number of reported cases. Some argue that if the incidence is rising, then environmental factors play a greater role; while if it is being reported more often, genetics deserves more attention. Others argue that rising incidence can be explained primarily by genetics. One theory, particularly associated with Simon Baron-Cohen, suggests that increased social mobility and assortative mating may lead to the genetic amplification of autistic traits. Natural selection of traits useful in the information age has also been noted.

Anecdotal reports from school districts and physicians lend support to the impression that the incidence is rising, and some studies appear to support this as well. Some believe the incidence has risen markedly in the last few years, from about one in 5000 to estimates ranging between one in 400 or even as high as one in 166, and believe we are facing a major societal problem. In the United States, the Centers for Disease Control (CDC) has vacillated between the latter two figures. In January of 2004 the CDC sent out and autism alarm to all pediatricians stating that they believed that one in 166 children had an autism spectrum disorder and far worse one in 6 now suffered from a neurodevlopmental or behavioral disorder. Othes have put these figures as high as one in 40 for autism and one in 3 for the neurodevelopmental or behavioral disorders.

Others point out that several factors are likely to cause increased reporting. First, the broadening definition of autism, which began most markedly with revised classifications in DSM-III-R in 1987, and the greater availability of services for autistic individuals, some say, creates an incentive to be inclusive in the diagnosis. Second, the last few decades have seen a greater awareness of autistic traits among pediatricians and other medical specialists. It is surmised that some children who were previously diagnosed as retarded, or as having a psychotic disorder, are now diagnosed as autistic, or with PDD. Autism was once believed to be a type of childhood schizophrenia.

It will take time to resolve these diagnostic prevalence issues. As noted above, there is no definitive, standardized way to diagnose autism. This problem applies both for purposes of measuring past, present and future incidence. There are important implications from this controversy, because the answer will guide both the allocation and magnitude of research, legal action, and therapy.

Genetics and autism

There is evidence that autism has a genetic component, and ongoing research focuses on finding the biomarkers that determine autistic phenotypes. But there is significant disagreement as to whether genes contribute to a vulnerability to environmental triggers, or have another role in the etiology of autism.

There is a trend in research towards viewing genetics as an underlying factor. However, most autistic children have apparently neurotypical parents, which suggests that a single gene cannot be the cause. The spectrum of autistic disorders is notable for its significant gender disparity, with the incidence of autism in males greatly exceeding the incidence in females. A 1994 study estimated the ratio at three males to one female, while a 1982 Japanese study indicated a ratio of nine to one. Several studies on human and animal tissue suggest that testosterone potentiates the toxic effects of mercury, hence any gender disparity has been suggested to add credence to the theory that mercury plays a role in the etiology of autism. There are some, however, who speculate that autism occurs equally in both sexes, and that males are simply more likely to be diagnosed because of differences in childhood socialization.

Scientists have recently (July, 2005) shown that variations in the gene for protein kinase C beta 1 (PRKCB1), a protein with an important role in brain function, are strongly associated with autism. This exciting finding suggests some answers to a number of previous, but unexplained, observations about autism and provides the potential for a mechanistic explanation for some of the characteristics of the condition.

Implications of genetic testing

If and when genetic testing for autism becomes available, it is anticipated that many women pregnant with an autistic child will decide to abort the pregnancy. There is some precedent from Down's Syndrome which points in this direction. Autism rights advocates believe this will be akin to genocide. Furthermore, the impact of such an event on the human species as a whole could be very significant. Assuming that it is true that people such as Albert Einstein and Isaac Newton were autistic, as some speculate, common pro-life arguments such as "What if the next Einstein were to be aborted?" would potentially be more biologically persuasive.

Vaccines and autism

In the late 1990s, controversial theories arose linking childhood vaccinations to autism.

Thimerosal

MMR triple vaccine

Intelligence and autism

Until recently, a large proportion of children diagnosed as having autism were also believed to have mental retardation. The term 'mentally retarded' itself is debatable because this determination is based on IQ testing, which has its own set of controversies and detractors. A more accurate description would be to say that children who are diagnosed autistic may also have low IQ scores. However, this view is inconsistent with other findings, particularly the increased incidence of 'high functioning' autism and the recognition of Asperger's syndrome as being part of the autism spectrum.

Autistic persons who have normal or high intelligence are often not diagnosed with autism, so the average IQ of the autistic community as a whole cannot be determined. Furthermore, anecdotal accounts of autistic children whose IQ scores have increased dozens of points over a relatively short period of time are not uncommon. It has been suggested that these increases do not correspond to an increase in actual intelligence however; perhaps, like any children, the autistics may simply get better at taking IQ tests (the so-called practice effect).

Characteristics observed by some studies as being associated with gifted children at least appear to be analogous to those of autistic children:

• Some studies suggest that gifted children are more than twice as introverted as their peers.
• Gifted children have been characterized as having obsessive interests, as playing alone and enjoying solitude. They are also said to have prodigious memories and show intense reactions to noise, pain and frustration.
• According to some reports, gifted children have a higher than average propensity to allergies

These findings have led to speculation that high intelligence and autism are related. Autistic author Temple Grandin speculates that genius itself "may be an abnormality."

An alternative view is that autism and intelligence are unrelated; autistics with all levels of intelligence have been observed. According to this view, autistics with low intelligence would be more likely to be recognized and diagnosed as autistic. Those with normal to high intelligence might be better able to articulate their experiences (either verbally or through writing). These autistics might be labeled as high functioning regardless of their other neurological deficits.

Prognosis for autistic children

Children who are diagnosed with autism face a great range of outcomes. Some are reported to have learned speech and/or writing, self-care, and social skills on their own. Others experience an apparently miraculous "recovery" and begin behaving in a way that is generally indistinguishable from the way non-autistics behave, either for no apparent reason or, apparently, from a few simple alterations in diet. Some become mainstreamed after years of hard work and intensive training. Some develop slowly, but never become typical. There are a few who never move beyond a level of functioning that society perceives as 'low'. Yet others are fairly typical during childhood and report becoming "more autistic" in adulthood.

It seems paradoxical that while some people see early intervention as crucial for autism, the prognosis is also most uncertain the younger the child is. An idiosyncratic development path may be confused with a more severe disorder, and the child may 'catch up' on his/her own. Research indicates that the human mind and nervous system remains plastic for longer than originally thought, and autistic persons, like those with learning disabilities, have been known to develop all their lives.

There is broad consensus in the medical community to the effect that autistic behaviors can be improved through training, medical or educational interventions, though there is wide disagreement on what the right kinds of treatment are and what the appropriate objectives should be.

See also

• List of autism-related topics
• A-CHAMP
• Autism
• Autism rights movement
• Aspies For Freedom
• Autistic culture
• Chelation therapy
• Generation Rescue
• Mark Geier
• Richard Deth

References

1. www.a-gifted-child.com
2. www.jewishworldreview.com
3. www.sengifted.org
4. www.onlineparadigm.com

External links

Autism rights movement

• 1st.net - 'CIBRA: Children Injured by Restraints and Aversives'
• ANI.ac - 'Autism Network International, an autistic-run self-help and advocacy organization for autistic people'
• ATT.net - 'Autistic Advocacy: A repository for my articles, editorials, and questionable attempts at humor', Frank Klein
• AutCom.org - Autism National Committee
• Autistics.org - 'Autistics.org: The Real Voice of Autism' (esources by and for persons on the autistic spectrum)
• GettingTheTruthOut.org (photographs and first-person writing, presenting the appearance and subjective experience of an autistic person, discussing ways in which her self-perception differs from what other see of her apparent condition)
• ISN.net - 'Oops.. Wrong Planet Syndrome'

• ISN.net - 'Our Names are Autism, Too', Janet Norman-Bain (September 11, 2004)

• JimSinclair.org - Jim Sinclair* NetCom.com - 'Less Frustration -- the thing we all strive for'
• NeuroDiversity.com - 'neurodiversity.com: honoring the variety of human wiring'
• Sentex.net - 'No Autistics Allowed: Explorations in Discrimination Against Autistics', Michelle Dawson
• SimpleComplexities.org - 'Asperger's Syndrome World Community: The Nation of Asperocria' (autism rights community)
• ZolaWeb.com - 'Feeling Stressed? For therapy, try making Teddy Bears!' Jane Meyerding

Internet Autism Rights Movement campaigns

In the early 2000s, activist campaigns started over the Internet.

• In April 2000, Autistics.org hosted an online counter-rally called "Hear Our Voices" to protest an autism rally in Washington D.C. called "Hear Their Silence" that they disagreed with.
• In 2004, a Autistic Adults Picture Project was started in response to similar projects started by parents that only include pictures of children.
• In September 2004, the "Our Names are Autism Too" is a campaign that protested an article titled "My Name is Autism" that presented a view autism rights activists found insulting.
• In October 2004, the Signatures of Intolerance campaign was started over controversy surrounding ABA in Canada.
• In 2004, the Petition to Defend the Dignity of Autistic Citizens was started to protest the use of insults to describe autism (such as "mad child disease").

Groups for parents of autistic people

• MAAPServices.org - 'The Source', MAAP Services for Autism and Asperger's Syndrome

Research organizations on autism

• Yale.edu -

'Information About Pervasive Developmental Disorders' (Yale University's Pervasive Developmental Delay Clinic)

• Sunderland.ac.uk - The Autism Research Unit at the University of Sunderland, UK

• Autism
• Controversies